None listed
Conditions
Brief summary
Patients that present to Emergency Departments with syncope are some of the most difficult to diagnose. Syncope (fainting, collapse) is a temporary loss of consciousness with a spontaneous return to normal function. There are many causes of syncope, some serious and some trivial. There are a number of ways to determine whether a patient has a serious cause (and should be admitted to hospital and undergo further testing and observation) or a trivial cause and can be discharged home. One way is the San Francisco Rule, which looks at five factors. These factors are: using the acronym CHESS, C-history of congestive cardiac failure, H-haematocrit <30%, E-abnormal ECG, S- shortness of breath, S- systolic blood pressure <90. However, the accuracy of this rule is variable. There have been suggestions that looking at an additional factor, like a specific blood test for heart failure, may improve the accuracy of this rule. The aim of this project is to determine whether the use of the San Francisco Syncope Rule (SFR) with the addition of a Brain-Naturetic Peptide (BNP) blood test can result in an improvement in the outcomes of patients who present to Emergency Departments (ED) with syncope.
Interventions
An additional 5ml of blood will be drawn with the initial blood taken for standard clinical managment during patients presentation to ED for syncope. If blood is not being taken for clinical care, patient will be asked if they wish to take part in the study and provide a blood sample. The blood will be tested for Brain-Natriuretic peptide levels using the Alere Triage machine. There will be no storage of blood, other than temporarily if the testing needs to be done at a later date.
Data will be
An additional 5ml of blood will be drawn with the initial blood taken for standard clinical managment during patients presentation to ED for syncope. If blood is not being taken for clinical care, patient will be asked if they wish to take part in the study and provide a blood sample. The blood will be tested for Brain-Natriuretic peptide levels using the Alere Triage machine. There will be no storage of blood, other than temporarily if the testing needs to be done at a later date. Data will be collected using a standardised data collection form. Patients will be managed and discharged as determined by their treating clinician as per their clinical judgement - the trial blood sample will not be available to clinicians. Patients will be recruited for 12 months with the aim for at least 450 patients. Patients will be telephoned by research nurses at approximately 30 days post ED discharge and asked a series of standard questions regarding their health and investigations since ED discharge. Hospital summaries and results of investigations will be obtained by research staff. The San Franciso Rule will be applied to the patient data retrospectively, there will be no change to patient care. The San Francisco Rule considers patients with an abnormal ECG, a complaint of shortness of breath, haematocrit less than 30%, systolic blood pressure less than 90 mm Hg or a history of congestive heart failure is at risk of an adverse outcome and should be admitted for futher investigation.
Sponsors
Karen Shakespeare
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients presenting to Hospital Emergency Departments with “Collapse”, “Syncope” or “Faint” will be eligible for recruitment.
Exclusion criteria
Patients < 18 years old, pregnancy,altered mental state, alcohol or illicit drug-related loss of consciousness, a definite seizure or transient loss of consciousness caused by head trauma, inability to obtain consent, and likely inability to conduct follow-up (e.g. overseas visitors).
Outcome results
None listed